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Last Name:
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First Name:
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Middle Initial
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Residence Address:
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City:
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State:
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Zip:
Mailing Address:
City:
State:
Zip:
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County:
Hawaii (County of Hawaii)
Kauai (County of Kauai)
Maui (County of Maui)
Oahu (City & County of Honolulu)
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Primary Phone:
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(Numbers only. Example: 8081112222)
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Work Phone:
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ext:
Email:
Best time to call:
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Election Available:
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Primary
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Political Party Affiliation:
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Democratic
Libertarian
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None
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Previous Experience:
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If yes, last election year worked:
2008
2006
2004
2003
2002
2000
1998
1996
1994
1992
1990
1988
1986
1984
1982
1980
If yes, previous position:
Precinct Official
Precinct Voter Assistance Official
Precinct Chairperson
Facility Official
Control Center Operator
Counting Center Official
Delivery/Collection Chair
Delivery/Collection Member
Other
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Second Language (fluent):
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Chinese
Ilocano
Japanese
Other
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Location you would like to work at:
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Office Use Only: